Part D costs can add up quickly. Not only do you have to pay monthly premiums, you will pay an annual deductible and a coinsurance or copay for any medications you receive. Depending on what medical conditions you have and what medications you take, you may need Extra Help paying for your medications.

What Is the Part D Low Income Subsidy (LIS)?

Also known as Extra Help, the Part D Low Income Subsidy (LIS) is a federal subsidy program that helps to pay down part or all of your Part D expenses. The program looks at your current income and assets to decide if you need assistance. The Social Security Administration estimates it saves beneficiaries an average of $5,100 every year!

Anyone who qualifies for both Medicare and Medicaid is automatically eligible for the subsidy, and they will receive full benefits. Likewise, anyone on one of the Medicare Savings Programs — specifically the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Individual (QI) Programs — gets automatic enrollment with full benefits. Finally, anyone actively receiving SSI benefits with an income less than 135% of the federal poverty limit (FPL) and who meets asset criteria is automatically enrolled for full Extra Help.

All other people will need to see if they qualify and apply to participate in the program. They may receive either full or partial benefits depending on their income and assets.

2022 Extra Help with Full Benefits

Only the most financially in need qualify to get the full benefit. With no premiums or deductibles to pay, your benefits start with your very first prescription. How much you pay is based on whether you are prescribed a generic or brand-name medication.

Eligibility Group	What You Will Pay	Income Limits*	Asset Limits
People eligible for Medicaid – AND – Live in an institutional facility or receive home health services	Part D premium: $0 Part D deductible: $0 Copay (generic): $0 Copay (brand): $0	Based on state Medicaid eligibility requirements	Based on state Medicaid eligibility requirements
People eligible for Medicaid – AND – Income level </= 100% FPL	Part D premium: $0 Part D deductible: $0 Copay (generic): $1.35 Copay (brand): $4.00	Based on state Medicaid eligibility requirements	Based on state Medicaid eligibility requirements
People eligible for Medicaid – AND – Income level > 100% FPL	Part D premium: $0 Part D deductible: $0 Copay (generic): $3.95 Copay (brand): $9.85	Based on state Medicaid eligibility requirements	Based on state Medicaid eligibility requirements
Income </= 135% FPL – AND – Low assets	Part D premium: $0 Part D deductible: $0 Copay (generic): $3.95 Copay (brand): $9.85	Single: $1,549 per month $18,587 per year    Married: $2,080 per month $24,959 per year	Single: $9,900    Married: $15,600

2022 Extra Help with Partial Benefits

Unlike the full benefit program, some people who receive partial benefits may need to pay a portion of their Part D premiums. They all have to pay a $99 deductible though. That said, the deductible is significantly lower than the maximum deductible set by the federal government each year ($480 in 2022). At first, the drug discount is lower than what you would receive with the full benefit program. Once you reach the level for catastrophic drug coverage ($7,050 in out of pocket costs in 2022), you will receive the full benefit rate for each drug you take.

Eligibility Group	What You Will Pay	Income Limits*	Asset Limits
Income </= 135% FPL – AND – Medium assets	Part D premium: $0 Part D deductible: $99 Coinsurance: 15% Copay (catastrophic – generic): $3.95 Copay (catastrophic – brand): $9.85	Single: $1,549 per month $18,587 per year    Married: $2,080 per month $24,959 per year	Single: $9,900 – $15,510    Married: $15,600 – $30,950
Income 135 – 150% FPL	Part D premium: Sliding scale Part D deductible: $99 Coinsurance: 15% Copay (catastrophic -generic): $3.95 Copay (catastrophic – brand): $9.85	Single: $1,719 per month $20,625 per year    Married: $2,309 per month $27,705 per year	Single: $15,510    Married: $30,950

An Added Bonus

If got caught with Part D late penalties before you became eligible for Extra Help, they get wiped when your Extra Help benefits start. That’s right. They go away forever, saving you even more.‌

 

Extra Help with Medicare Prescription Drug Plan Costs. (2022). SSA.gov. https://www.ssa.gov/benefits/medicare/prescriptionhelp.html

Help with drug costs. (2022). Medicare.gov. https://www.medicare.gov/basics/costs/help/drug-costs

Poverty Guidelines | Office of the Assistant Secretary for Planning and Evaluation. (2022). ASPE. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines

 

Current Year: 2022

Subsequent Years: 2023 | 2024